What is the Child-Pugh Score?
The Child-Pugh score classifies the severity of chronic liver disease (cirrhosis) and estimates prognosis. It originated from work by Child and Turcotte in 1964 and was modified by Pugh and colleagues in 1973, who replaced nutritional status with hepatic encephalopathy grading and added prothrombin time/INR. It remains widely used for estimating surgical risk in cirrhotic patients and general prognosis, even though MELD-Na has largely replaced it for transplant allocation.
How to calculate Child-Pugh
Five parameters, each scored 1–3 points:
| Parameter | 1 point | 2 points | 3 points |
|---|---|---|---|
| Bilirubin | <2 mg/dL | 2–3 mg/dL | >3 mg/dL |
| Albumin | >3.5 g/dL | 2.8–3.5 g/dL | <2.8 g/dL |
| INR | <1.7 | 1.7–2.3 | >2.3 |
| Ascites | None | Mild | Moderate–severe |
| Encephalopathy | None | Grade I–II | Grade III–IV |
Interpretation
| Score | Class | ~1-year survival |
|---|---|---|
| 5–6 | A | ~100% |
| 7–9 | B | ~80% |
| 10–15 | C | ~45% |
Child-Pugh vs. MELD-Na
MELD-Na is now the standard for liver transplant allocation because it's more objective (lab-based only) and better predicts short-term mortality. Child-Pugh remains useful for general prognosis and for estimating perioperative risk in cirrhotic patients undergoing non-transplant surgery. See the MELD-Na calculator for transplant-priority assessment.
References
Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973.